In this second programme in the series, Claudia considers the value and the accuracy of diagnoses in mental health. Unlike a broken wrist, diabetes or anaemia, where you can be fairly hopeful that the testing makes the diagnosis watertight, there is not a single x-ray, blood test or biopsy that can give a definitive diagnosis of a mental health problem. Instead the symptoms that a person describes are assessed and a diagnoses given based on how they cluster and fit with diagnostic categories. The whole process is much more fluid, with many symptoms shared or absent both within and between different disorders and conditions.
As Suzy describes, a mental health diagnosis can be seismic for the person concerned. In a positive way it can bring recognition, relief, treatment and recovery and in a negative way it can bring judgement, prejudice, discrimination and isolation. Because a diagnosis in mental health is above all, intensely personal. It can feel aimed at the very centre of you and your identity.
Claudia explains the backdrop to the classification of mental health conditions. She looks at the Psychiatrists’ Bible, a.k.a. the DSM or the Diagnostic and Statistical Manual and considers the enormous growth in each of five volumes published over the past 70 years (it’s said the last edition is big enough to stop a bullet). How does this American framework affect how we view, assess and treat mental health difficulties in this country?
There are some who disagree profoundly with formal classification framed by the DSM, describing it an inappropriate “medical model” for mental health problems. Claudia talks to clinical psychologist, Dr Lucy Johnstone, who has never, in her 30 year career, given a diagnosis and believes the starting point should be not “what’s wrong with me?” but “what’s happened to me?”. But Claudia also hears from others, including the former President of the Royal College of Psychiatrists, Professor Sir Simon Wessely, who maintain diagnoses are accurate, valuable and flexible enough so that good clinicians can use them as the starting point for care.
D for Diagnosis, BBC Radio 4, 19th July 2019